THE EFFECT OF YOGA ON SLEEP QUALITY AND INSOMNIA IN WOMEN WITH SLEEP PROBLEMS : A SYSTEMATIC REVIEW

Background: With prevalence estimates ranging from 4% to over 20% of the adult population, insomnia is the most prevalent sleep complaint and a serious public health problem. Yoga has also been utilized therapeutically since it is thought that various styles of yoga might have distinct psychophysiological effects. Aims : This systematic review is to review the effect of yoga on sleep quality and insomnia in women with sleep problem. Methods: This study demonstrated compliance with all requirements by means of a comparison with the standards established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. Thus, the specialists were able to guarantee that the research was as current as feasible. Publications released between 2014 and 2024 were considered for this search strategy. This was accomplished by utilizing a number of distinct online reference sites, including Pubmed, ScienceDirect, and SagePub. It was determined that reviews, previously published works, and partially completed works would not be included. Result: In the PubMed database, the results of our search brought up 33 articles, whereas the results of our search on SAGEPUB brought up 416 articles, our search on SCIENCE DIRECT brought up 1107 articles. The results of the search conducted for the last year of 2014 yielded a total 26 articles for PubMed, 265 articles for SAGEPUB and 684 articles for SCIENCE DIRECT. In the end, we compiled a total of 7 papers, 4 of which came from PubMed, 1 of which came from SAGEPUB and 2 of which came from SCIENCE DIRECT. We included seven research that met the criteria. Conclusion: In summary, when compared to non-active control settings, yoga intervention can help women manage their sleep issues in either pregnant women, worker, or women with disease.


INTRODUCTION
The prevalence of sleep disorders rises with age, with an estimated 67% of the elderly reporting sleep-related complaints.Older adults have been linked to a number of sleep-related issues, such as difficulty falling asleep, sleep disturbances at night, and less attentiveness throughout the day.Poor sleep quality has been directly linked to higher rates of mental and physical illness, a deterioration in cognitive performance, and a lower quality of life (QOL), according to research. 1 Sleep helps the body heal and rebuild itself, facilitating learning and memory consolidation.But a lot of individuals have trouble sleeping due to conditions including restless legs syndrome, sleep apnea, and insomnia.Physical activity is one way to improve sleep quality and reduce the risk of sleep disorders since there is a reciprocal association between physical activity and sleep quality. 2 Sleep quality, which is defined by difficulty falling or staying asleep and the number of nighttime awakenings, is the most important predictor of sleep status.Insomnia, which is characterized as persistent dissatisfaction with sleep quantity or quality along with difficulties falling asleep, many awakenings during the night with difficulty going back to sleep, and/or getting up earlier than intended, is the most common sleep quality issue.According to studies, the prevalence of insomnia varies from 10% to 30%, and in certain situations, it can even reach 50% or 60%.This sleep problem is more common in women, elderly persons, and people with physical and mental health issues.[5] The impact of exercise on sleep is a topic of increasing interest for researchers.Regular physical exercise has been linked to longer and better-quality sleep, according to studies.According to scientific research, persons who worked out for at least half an hour every day slept for an average of fifteen minutes longer than those who did not.Physical exercise has been linked to a decrease in sleep problems, including sleep apnea, daytime drowsiness, and insomnia, according to other research.Studies have also shown that people with insomnia can get better-quality sleep when they engage in moderateintensity exercise.It was shown that individuals suffering from insomnia who engaged in thirty minutes of physical activity three times a week for eight weeks had better-quality sleep.Additionally, those with insomnia benefit from moderate-intensity aerobic exercise in terms of sleep quality. 6

METHODS Protocol
The author of this study ensured that it complied with the standards by adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines.This is done to guarantee the accuracy of the results that are derived from the investigation.Thus, the specialists were able to guarantee that the research was as current as feasible.Publications released between 2014 and 2024 were considered for this search strategy.This was accomplished by utilizing a number of distinct online reference sites, including Pubmed, ScienceDirect, and SagePub.It was determined that reviews, previously published works, and partially completed works would not be included.

Criteria for Eligibility
In order to completse this literature evaluation, we looked at published research that discusses the effect of yoga on sleep quality and insomnia in women with sleep problem..This is done to enhance the patient's therapy management and to offer an explanation.This paper's primary goal is to demonstrate the applicability of the issues that have been noted overall.
To be eligible to participate in the study, researchers had to meet the following requirements: 1) English must be used to write the paper.The manuscript must fulfill both of these conditions in order to be considered for publication.2) A few of the examined studies were released after 2013 but prior to the time frame considered relevant by this systematic review.Editorials, submissions without a DOI, already published review articles, and entries that are nearly exact replicas of journal papers that have already been published are a few examples of research that are prohibited.

Data retrieval
After reading the abstract and the title of each study, the writers performed an examination to determine whether or not the study satisfied the inclusion criteria.The writers then decided which previous research they wanted to utilise as sources for their article and selected those studies.After looking at a number of different research, which all seemed to point to the same trend, this conclusion was drawn.All submissions need to be written in English and can't have been seen anywhere else.

Figure 1. Prisma Flow Diagram
Only those papers that were able to satisfy all of the inclusion criteria were taken into consideration for the systematic review.This reduces the number of results to only those that are pertinent to the search.We do not take into consideration the conclusions of any study that does not satisfy our requirements.After this, the findings of the research will be analysed in great detail.The following pieces of information were uncovered as a result of the inquiry that was carried out for the purpose of this study: names, authors, publication dates, location, study activities, and parameters.

Quality Assessment and Data Synthesis
Each author did their own study on the research that was included in the publication's title and abstract before making a decision about which publications to explore further.The next step will be to evaluate all of the articles that are suitable for inclusion in the review because they match the criteria set forth for that purpose in the review.After that, we'll determine which articles to include in the review depending on the findings that we've uncovered.This criteria is utilised in the process of selecting papers for further assessment.in order to simplify the process as much as feasible when selecting papers to evaluate.Which earlier investigations were carried out, and what elements of those studies made it appropriate to include them in the review, are being discussed here.

RESULT
In the PubMed database, the results of our search brought up 33 articles, whereas the results of our search on SAGEPUB brought up 416 articles, our search on SCIENCE DIRECT brought up 1107 articles.The results of the search conducted for the last year of 2014 yielded a total 26 articles for PubMed, 265 articles for SAGEPUB and 684 articles for SCIENCE DIRECT.In the end, we compiled a total of 7 papers, 4 of which came from PubMed, 1 of which came from SAGEPUB and 2 of which came from SCIENCE DIRECT.We included seven research that met the criteria.Buchanan, et al 7 (2017) showed that with the possible exception of maybe better sleep stability with yoga in women with low self-reported sleep quality, the treatments had no statistically significant benefits on actigraph measurements, despite minor effects on self-reported sleep quality having previously been documented.
Khalsa, et al 8 (2021) showed that at the 6-month follow-up, yoga, taught within a self-care framework with little teacher load, was linked to self-reported gains that went above and beyond an active comparison of sleep hygiene.Additional research is required to evaluate the results of actigraphy and polysomnography, as well as potential processes of change.
Newton, et al 9 (2014) showed that yoga had no impact on VMS frequency or annoyance in this randomized controlled study.Yoga did, however, somewhat alleviate the symptoms of sleeplessness, another significant menopausal symptom for midlife women.When compared to regular activity, a 12-week yoga class plus at-home practice did not enhance the frequency or annoyance of VMS in healthy women, but it did lower the symptoms of sleeplessness.
Basavegowda, et al 10 (2023) showed that during the COVID-19 epidemic, workplace yoga intervention seems to be a viable strategy to improve QoL and reduce sleeplessness among female nurses and healthcare professionals.Adopting customized yoga programs for the workplace may be quite beneficial in fostering the resilience and general well-being of healthcare personnel, which in turn can lead to a happier workplace and better patient outcomes.Brazil Randomized controlled trial 47 patients Both groups showed improvement over time in respect to the intensity of the insomnia symptom (M + SH p = 0.001) (SH p = 0.005).The KMI index significantly improved for the intervention group (p = 0.024).The PSQ overall score improved for the control group (p = 0.016).ANOVA two-way test results in a significant difference (0,026) in KMI between the groups, indicating that meditation may be useful in reducing climatic symptoms.Pasyar et al, 2019 13 Iran Randomized controlled trial

patients
Regarding role functioning of quality of life, there was a significant change between the groups four weeks after the intervention (P = 0.03).After eight weeks of the intervention, there was a substantial difference (P<0.05) in the groups' quality of life in terms of both physical and emotional functioning.Physical, role, emotional, and cognitive performance had all changed, and the intervention group's ratings on several measuressuch as weariness, pain, sleeplessness, and financial difficulties-had decreased.
On the fourth and eighth week following the intervention, there was no discernible difference in the amount of edema between the two groups (P > 0.05).
Azward, et al 11 (2021) showed that third-trimester pregnant women's sleep quality is improved by prenatal yoga workouts.Most pregnant women in their third trimester had poor quality sleep before receiving yoga exercises intervention.However, after receiving yoga exercises intervention four times, it was discovered that respondents found it easier to fall asleep due to complaints about their back pain and inability to breathe comfortably.This is because yoga exercises help to reduce pregnancy-related complaints by promoting relaxation and calmness in the body, mind, and soul. in order for the quality of each respondent's sleep to improve from inadequate to satisfactory.
Portella, et al 12 (2021) showed that working women's quality of life may be enhanced by Raja Yoga meditation, which may offer a non-pharmacological option for managing menopause-related symptoms and sleep quality throughout the late menopausal transition.
Pasyar, et al 13 (2019) showed that yoga exercise can be recommended as an intervention for women with lymphedema associated to breast cancer, as it has the potential to enhance physical, emotional, and role functioning of quality of life while also reducing pain, exhaustion, and sleeplessness.

DISCUSSION
With prevalence estimates ranging from 4% to over 20% of the adult population, insomnia is the most prevalent sleep complaint and a serious public health problem.Yoga is a complete system that combines a broad range of postures and exercises, breathing exercises, relaxation methods, meditation, and mindfulness practices with the goal of attaining physical, psychological, and spiritual health and well-being.Yoga has also been utilized therapeutically (sometimes known as "yoga therapy") since it is thought that various styles of yoga might have distinct psychophysiological effects, and that these effects can be targeted to certain diseases.The study by Khalsa, et al in 157 women aged 25-59 year old with primary complaint of insomnia intervent with yoga with result that yoga associated with improvements and beyond an active sleep hygiene comaprison. 8 a study of 186 late and postmenopausal women age 40-62 year old in study by Buchanan, et al, women asked to do 12 weeks of yoga, and the result showed there is small efects on sleep quality and potentially improved the sleep quality with yoga in women. 7The study of efficacy of yoga also studied by Newton, et al in 249 women, that devided into 107 patients with yoga, 106 patients did exercise and 142 patients in usual activity.The result of this study showed that among the healthy women, 12 weeks of yoga improve the sleep quality by reduced insomnia symptoms. 9search has indicated that several categories of people often have lower psychological well-being.These categories include women, nurses, front-line healthcare professionals, those employed in "hot spots" for disease outbreaks, people with less social support, and people with poorer self-efficacy.The study by Basavegowda, et al that included 173 participants, with 57 of them had insomnia showed the results that yoga programs can promote the well being and resilience of the workers, and improved outcomes of insomnia in workers. 10Pasyar, et al in their study also showed that in 40 women with breast cancer related lymphedema, yoga might improve the quality of life of patients as reduce fatique, pain and insomnia. 13ward, et al did study to profe the effect of prenatal yoga on sleep quality in pregnant women.This study with 60 pregnant women with gestational age 28 weeks and devided into 2 groups of control and the one who given prenatal yoga 4 times in 2 weeks.The result showed that yoga in pregnant women showed the increased of sleep quality. 11Portella, et al in their study also showed that in 47 women between 40 and 55 year old worker, yoga may be a non pharmacological alternative for sleep quality and improve the working women's quality of life. 12

CONCLUSION
In summary, when compared to non-active control settings, yoga intervention can help women manage their sleep issues in either pregnant women, worker, or women with disease.